The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy

Abstract

HighlightsThe sensitivity of routinely performed CT for pleural malignancy was only 58%.Nearly half of the malignant cases had a benign CT (negative predictive value 54%).CTPA and non-specialist radiology reporting were associated with lower sensitivity.CT specificity was 80%, and was not affected by use of CTPA or specialist reporting.Pleural malignancy is frequently occult on routinely acquired CT imaging.

Progress and challenges in Mesothelioma: From bench to bedside

“…In females, a direct exposure history may be absent but indirect (nonoccupational) contact may be traceable via a spouse or parent. Rightsided disease tends to predominate [4] but routinely available tests, such as Computed Tomography (CT) imaging [5,6], pleural fluid cytology [7] and closed pleural biopsies [8] offer poor sensitivity. Patients should therefore have early access to specialist diagnostics, including Local Anaesthetic Thoracoscopy (LAT), expert pathology review and the support a Mesothelioma Clinical Nurse Specialist and MPM-focused multi-disciplinary team.…”

“…Additional but equally important questions surround the role of early detection of MPM, which was identified as a key priority for patients during the recent James Lind Alliance Priority Setting Partnership (see associated website information). However, based on the literature to date, we can infer that in incident cases of MPM only 1/3 of patients will have visible pleural plaques [4] and only 2/3 will have a positive Mesothelin blood test (the current best of the circulating markers) [26] or a CT scan with obvious morphological evidence of pleural malignancy [5,6]. This suggests that we do not currently have the necessary detection tools to run an accurate screening programme, particularly since the prevalence of MPM will be considerably than lower in this setting than in the symptomatic, incident populations included in the studies referenced above.…”

Development and Maintenance of a Pleural Disease Service: Role of the “Pleurologist”

“…Pleural phase (portal venous phase) computed tomography imaging of the chest optimizes diagnostic sensitivity in pleural malignancy. 29 Specialist thoracic radiology interpretation also provides a higher diagnostic accuracy then general radiology interpretation. Specialist thoracic pathology is a critical part of a pleural service particularly in the challenging pathological diagnosis of mesothelioma and the differentiation between benign atypical mesothelial proliferation versus epithelioid mesothelioma and fibrous pleuritis versus sarcomatoid mesothelioma.…”

Investigation of a unilateral pleural effusion: What CT scan coverage is optimal?

“…Undiagnosed unilateral pleural effusions are common and have a wide range of underlying aetiologies, with malignancy high on the differential diagnosis list 1. The British Thoracic Society (BTS) pleural guidelines recommend the use of CT which has a sensitivity of 58%–68% and specificity of 78%–80% for diagnosing pleural malignancy 2 3. The use of CT in this situation is well established, however, there is no consensus with regard to the inclusion of the entire abdomen and pelvis in the initial imaging protocol.…”